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Ireland rose to first place in Bloomberg’s Covid Resilience Ranking in September, but have we really done better than other countries over the whole pandemic?
According to the headline numbers of Covid-19 deaths, Ireland’s experience has been somewhat better than average. Closer examination of the mortality data indicates that, especially considering its context, Ireland has in fact been among the best countries worldwide in managing the pandemic over the past 18 months.
The official number of deaths from the virus in the Republic was 5,209 up to September 22nd, 2021. At 104 deaths per 100,000 people, this mortality rate is the sixth lowest among the 27 EU member states and 12th lowest among the 38 OECD countries.
Estimates by the Economist show, however, that about 1,400 to 2,250 extra people have died since the start of 2020, compared with the numbers of deaths that would have been expected based on mortality trends before the pandemic. This estimate of “excess deaths” corresponds to only 28 to 45 deaths per 100,000 people.
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There are three possible explanations for why excess deaths could be much lower than reported deaths from Covid-19 – each of which likely contributed to the difference.
First, measures taken to control the spread of the disease are likely to have reduced deaths from other causes. Registered deaths for the year from April 1st. 2020, to March 31st, 2021, as reported by the Central Statistics Office, were lower than in the previous 12 months for the most common causes – cancers (by 228 deaths), heart and circulatory system diseases (by 381 deaths) and respiratory conditions (by 974 deaths). Suicides declined by 27 per cent (111 deaths), deaths in transport accidents by 22 per cent (19 deaths) and deaths from influenza by 87 per cent (90 deaths).
Second, some people who died from the virus may have otherwise died from other causes. This could account for some of the reductions in deaths from cancer, heart disease and respiratory conditions – but only some, since fewer people died from these causes in countries, such as New Zealand and Iceland, that largely kept the disease out.
Third, deaths from the virus may have been overstated. Per World Health Organisation (WHO) guidelines, Covid-19 statistics include “probable or possible deaths” – some of which may actually have a different primary cause. Among death registrations, which attribute each death to one underlying cause, only 3,518 deaths were counted as due to the disease between April 1st, 2020, and March 31st, 2021, which is only about three-quarters of the 4,599 reported Covid-19 deaths during the same period. Furthermore, deaths from respiratory system diseases showed the largest declines compared with the previous 12 months, suggesting that even registered Covid-19 deaths may include some that were incorrectly attributed as primarily due to the virus or at least that would have happened anyway without a Covid-19 infection.
Even though WHO guidelines apply to all countries, there is reason to believe that Ireland has attributed more deaths to the disease, relative to the standards applied in other countries. That’s because the difference between reported Covid-19 deaths and excess deaths is greater in Ireland than in most other countries, including countries which had very few Covid-19 deaths and negative excess deaths.
Using registered Covid-19 deaths (extrapolated to the present time) or using an assumption that Ireland averted a similar number of deaths as in similar countries, it is likely that Ireland’s true number of deaths caused by the virus lies between 3,500 and 4,000, or between 70 and 80 per 100,000 people.
This level of mortality from the virus in Ireland is lower than estimated for most countries worldwide. In Europe, only Norway, Iceland, Denmark and Cyprus are estimated to have had fewer Covid-19 deaths as a share of population, while Finland and Luxembourg have similar mortality rates. Globally, most countries with lower excess mortality rates than Ireland are island states without any land borders (for example, Australia, New Zealand, Japan and many small island states), aside from China, South Korea, Mongolia and Bhutan. Several countries in southeast Asia (Vietnam, Laos, Cambodia, Thailand, Malaysia) kept the virus out until recently, and some might keep mortality below Ireland’s rate due to younger populations and having vaccinated some people before their current Delta-driven outbreaks.
It is notable that Northern Ireland has reported 2,517 deaths from the disease up to September 22nd, or 132 per 100,000 people, and its excess deaths were about roughly equal to reported Covid-19 deaths in 2020, while the United Kingdom as a whole has had 199 reported deaths and 179 excess deaths per 100,000 people. The Republic’s lower mortality rate is only partly explained by its younger population, and these numbers therefore indicate that Northern Ireland and Britain had higher rates of infection. Among the list of countries which appear to have controlled the virus better than the Republic, only a handful have an open-land border to a country with Covid-19 prevalence rates as high as the UK – including China, Mongolia, Bhutan and Finland – and none of those borders are nearly as frequently crossed as that on the island of Ireland.
Germany and Canada are closest to Ireland in terms of outcomes when dealing with a similar context. Each has excess mortality rates that are somewhat higher than Ireland – but they both have older populations and both neighbour countries with higher Covid-19 infection rates than the UK (namely Poland, the Czech Republic and the US).
In addition, if the true deaths to date from the virus in Ireland are between 3,500 and 4,000, then the excess mortality data imply that actions to control the spread of the disease have saved between about 1,300 and 2,550 lives, or roughly one life for every two to three lives lost due to Covid-19.
The Covid-19 pandemic is not over. However, given Ireland’s exceptionally high levels of vaccination, and the effectiveness of vaccines, it seems likely that the worst is behind us. If so, then, despite the tragedy of many lives lost, Ireland will have weathered the pandemic better than most other countries.
Ireland’s relatively benign outcome is principally the result of prioritising lives and health. Of course, one can reasonably question whether particular restrictions were necessary; one can also question whether restrictions should have been stricter at times, especially last Christmas. Notably, Ireland’s lower Covid-19 mortality did not come at greater economic cost: among OECD countries, those with higher Covid-19 mortality tended also to experience greater, not smaller, economic losses, and Ireland is one of the first countries to recover economically to pre-pandemic levels.
Most of all, Ireland’s relatively low death toll from Covid-19 is due in the actions taken by Irish people over the past 18 months to protect themselves and each other. People have missed family funerals and weddings, lost jobs, and had their work, education and social lives disrupted. Many businesses have had to close down for long periods, and some may never reopen. Thankfully, these sacrifices have not been in vain; they have saved many lives.
Paul Callan is a strategy consultant with Dalberg Partners who works on social impact and global development